Welcome! The topic covered in this Power Point is SNAP Medical Expense Deductions (FMED)

Welcome! The topic covered in this Power Point is SNAP Medical Expense Deductions (FMED) 1

This Power Point will: Recognize who qualifies for FMED deductions. Discuss the types of allowable expenses. Review FMED verification requirements. Explain how FMED deductions are budgeted for SNAP. Illustrate proper coding of STAT/FMED. Identify common errors. Why are FMED deductions an issue? Cases that include FMED deductions are particularly error prone. Common errors include: Failure to recognize when units qualify for FMED deductions. Failure to budget FMED deductions correctly. 2

Units may receive a deduction based on medical expenses if they fit in ONE of the following groups. (Expenses may be paid or unpaid). Units with medical expenses for an eligible member age 60 or older, disabled, or receiving emergency SSI. Units with hospital or nursing home expenses for a person who is disabled or age 60 or older, and who was an eligible unit member before entering the hospital or nursing home. In addition, units responsible for unpaid medical bills of a deceased member who was disabled, or 60 or older also qualify for a deduction. The bills must have been incurred while the person was an eligible unit member. 3

Apply FMED deductions to all eligible, Stand-Alone SNAP households and Uncle Harry cases. FMED deductions do not affect MFIP Food Portion benefits. 4

FMED deductions include most incurred medical expenses that are prescribed and/or provided by a licensed, medical professional, and are not paid for by a third party. The list of allowed expenses is provided on Handout 2. 5

Do NOT allow the following expenses as medical deductions: Premiums for health and accident policies which pay lump sum settlements for death and dismemberment, or policies that continue loan or mortgage payments while a person is disabled. Expenses paid for or reimbursed by a source outside the unit (e.g. Medical Assistance, Medicare, Other Health Insurance). The cost of special diets. Enrollment fees up to $30 and any co-payments for Medicare-approved discount card programs paid by the unit. Medical drug discount credit ($600). Actual or standard medical expense for Medicare Drug discount participants. These are also listed on Handout 3. 6

Verification requirements are listed at the bottom of HO 1. Units must report and verify all medical expenses at application. At recertification, units must verify changes in recurring medical expenses that total more than $25, and they must verify any new expenses. Do not require units to verify expenses that have not changed at recertification. Units may, but are not required to, report changes in medical expenses during the certification period. If the unit voluntarily reports and verifies a change, process it following the proper procedures for acting on unscheduled changes. If you learn of a change in medical expenses from a source other than the unit (for example, MA information) act on the change if it is verified when you receive it. Do not contact the unit for additional information or verification. If the change needs additional verification, do not act on it until recertification. If a unit expects a medical expense at the time of certification but cannot verify at that time, allow the expense when they provide verification. 7

Before we move on and talk about how to code the FMED panel, let s take a short quiz. Who does not qualify for FMED deductions: A. Adults age 60+ B. MFIP Recipients C. Emergency SSI Recipients D. People with Disabilities 8

Answer: B., MFIP Recipients. People who receive MFIP Food Portion benefits do not qualify for FMED deductions. 9

Before we move on and talk about how to code the FMED panel, let s review more of what we ve learned. Which expense does NOT qualify as an FMED deduction? A. Hearing Aid B. Doctor Prescribed Aspirin C. Cost to Maintain a Special Diet D. PCA (Personal Care Attendant) Service 10

Answer: C. The cost of special diets does not qualify as an FMED deduction. Hearing aids, unreimbursed, out-of-pocket, over the counter medication approved by a state licensed practitioner or other health professional (e.g. daily aspirin therapy), and expenses associated with maintaining a PCA are all allowable medical expenses. Now that you are familiar with the policy let s look at an example of a SNAP case with FMED deductions. 11

Meet Betty and Elmer. Betty and Elmer are a married couple. Their only income comes from RSDI Retirement benefits, and they receive Medicare benefits through the Social Security Administration. Betty and Elmer both have out-of-pocket medical bills that often make it difficult for them to cover other living costs. In November, they applied for SNAP to help with their monthly grocery bills. As elderly SNAP recipients Betty and Elmer qualify for FMED deductions, which off-set the cost of their medical expenses. Betty and Elmer did not apply for any other types of assistance; this is a SNAP only case. 12

Betty s regular medical costs consist of: Her monthly Medicare Part B Premium, which costs $104.90 A monthly prescription, which costs $63.00, AND Another prescription that costs $24.50 per month. All expenses are verified. 13

This is a completed FMED panel for Betty. Type: We will explain each field and how to properly code it. This field is used to record the expense type. PF1 gives the valid codes for this field. For Betty the type codes used are: 09 Medicare Premium and 04 Prescriptions. Verification: This field is used to record the type of verification received for each medical expense claimed. PF1 gives the valid codes for this field. Reference Number : This field is used to record the reference number of the person who incurred medical expenses, if that person is a unit member. Remember, units may also claim medical expenses for former, eligible unit members who are currently hospitalized, nursing home residents, or deceased. Category: Use this field to list the category of eligibility that qualifies this person for a medical expense allowance: 1 Household Member 14

2 Former Aged/Disabled Eligible Household Member in a Nursing Facility or Hospital 3 Former Aged/Disabled Eligible Household Member Deceased 4 Other Eligible Begin Benefit: This field used to record the month and year that medical expense allowance begins to be counted for SNAP purposes (i.e. the month the expense is used). Betty and Elmer actually began paying Medicare Premiums several years ago, but the expense is first used as an FMED deduction in the month that they applied for SNAP. Therefore, we ll enter the application month in the Begin Benefit MM/YY field. Ending Benefit: This field is used to record the last month that this medical expense is allowed. For regularly recurring medical expenses, that are expected to continue indefinitely, leave the Ending Benefit field blank. MAXIS continues to count the expense, as long as all other information on the panel is complete. Units have the following choices, when budgeting non-recurring medical expenses. How the unit budgets the expense affects how the ending benefit field is coded. To allow the entire expense in one month, the Ending Benefit date will match the Begin Benefit date. To average the expense over the remaining months of the certification period, the Ending Benefit date is the last month of the current certification period (i.e. the month before the next Recertification is scheduled). Expenses count through the months listed. To allow the expense over the scheduled length of a payment plan. Clients may continue to use this expense as a deduction for the length of the payment schedule, even into another certification period. In this case, the Ending Benefit date extends as far into future the as necessary and is the last month the unit is responsible for the expense. Units may choose to have fluctuating expenses averaged. They may also choose to have expenses that are billed less often than monthly averaged forward over the interval between scheduled billings or, if there is no scheduled 14

interval, over the period the expense is intended to cover. Do not use medical expenses from one certification period for a later period unless a payment schedule extends into that period. For applicant units, expenses must have been billed for the first time in the billing period before application. The Ending Benefit field is particularly error prone. Mistakes can occur if: You leave the end date blank and deductions continue beyond the period they are intended to cover, OR You code an incorrect end date, resulting in either overpayments or underpayments. Betty s Medicare premium is a recurring expense. We can safely assume it will continue indefinitely. For this reason, we ll leave the Ending Benefit field blank. Monthly Expense Amount: This field is used to record the monthly expense amount for the benefit period. 14

Remember, policy allows deductions for transportation and lodging needed for medical care. We grant the same expense rate allowed for self-employment transportation. Enter the total number of miles claimed in the Miles field. This field is required anytime you use code 12 (Medical Transportation/Mileage Calculation) in the Type field. MAXIS enters the current IRS reimbursement rate (the 2013 rate is 56.5 cents per mile), and multiplies the number of miles by the rate per mile to determine the total expense. During COLA, MAXIS updates mileage rate and automatically recalculates medical transportation expenses. We re finished with Betty s FMED panel. Let s look at Elmer s expenses. 15

Elmer s medical costs consist of: His monthly Medicare Part B Premium, which costs $104.90, AND A second pair of eyeglasses, which cost $600. All expenses are verified. 16

Elmer s first expense is his monthly Medicare Part B Premium. We ll code this expense the same way we did for Betty. Use the following data to correctly code the expense: Type 09 Medicare Premium Verification Explanation of Benefits (Medicare/Insurance) Reference Number 02; Elmer incurred the expense. Begin Benefit 12/12; December 2012 is the first month we allow this expense as a deduction. Ending Benefit Leave Blank; this is a continually recurring expense. Monthly Expense - $104.90 In addition to his monthly Medicare Part B Premium, Elmer s other medical expense is a new pair of eyeglasses, which you confirm are neither paid for nor reimbursed by an outside source. This is a non-recurring expense, so Elmer has the option to use the deduction in the budget or, he can average the expense over the remaining months of the current certification period. 17

Because Betty and Elmer just applied for SNAP, they can budget the expense over the entire certification period. As a unit whose adults are ALL elderly or disabled, Betty and Elmer qualify for the maximum certification period of 24 months. In this example Betty and Elmer chose to have their expense averaged in this certification period. Therefore, we ll allow a $25 monthly deduction from the application month through the month prior to the recertification date. 17

When a case has FMED deductions MAXIS will generate an INFO message on your DAIL with your ELIG results. This message is to alert us that this case is error prone. Think of this message as a reminder to check your FMED panel(s) to be sure that all the information coded is up-do-date and accurate. View this message by going into STAT. Place an S in the selection field across from the INFO message. 18

In the edit summary, MAXIS generates an additional reminder to review the FMED panel for changes in medical expenses or medical eligibility that may affect the SNAP Budget. Review your FMED panel(s), then navigate to ELIG and check out your results. 19

The FSB1 panel shows where Medical expenses are subtracted from the SNAP budget. MAXIS lists total medical deductions for Betty and Elmer as $287. 20

This figure ($287.00) matches the total deductions listed on Betty and Elmer s FMED panels? A.True B.False 21

The answer is B. False. Total expenses listed on Betty and Elmer s FMED panels actually equal $322.30. 22

So, where does the $287 come from? For regularly recurring medical expenses, MAXIS subtracts $35 per unit from the actual monthly expense to determine the amount of the deduction. It s kind of like an insurance deductible. If a unit has both recurring and non-recurring expenses in a particular month, MAXIS still subtracts the $35.00 deduction. The system determines whether an expense is recurring or non-recurring based on a combination of the Expense Type and Ending Benefit codes on the FMED panel. You may notice that $322.30 minus $35.00 does not equal exactly $287.00. This is because MAXIS truncates each individual expense before adding them together and subtracting the $35.00. 23

What s the bottom line? What do FMED deductions mean for Betty and Elmer? What do they mean for you as financial workers? Betty and Elmer s monthly SNAP allotment is $250.00. Without FMED deductions their monthly benefit would drop to $16.00. FMED deductions provide Betty and Elmer an extra $234.00 per month ($2808.00 per year) to spend on groceries. The deduction also frees up funds, so that Betty and Elmer can pay some of their medical costs. For you, approving a case like this means avoiding potential costly errors and providing the best possible customer service to the clients you serve. 24

Now lets take a look at another case. Meet Christopher. Christopher is a 33 year old MA recipient. He is disabled and receives RSDI Disability and Medicare benefits from the Social Security administration. Christopher does not work and is eligible for MA with an automated monthly medical (AMM) spenddown of $366. His Medicare Part B premiums are paid by the SLMB program. The SLMB (Service Limited Medicare Beneficiary) Program is a Medicare Savings Program that covers Medicare Premiums for eligible individuals. Christopher meets the SLMB income limit, which is 120% FPG. Note: Disabled people between the ages of 16 and 64 with taxed, monthly income totaling over $65 are eligible for MA-EPD (Medical Assistance for Employed Persons with Disabilities). The fact that Christopher does not work is important because this is what makes him eligible for MA with a spenddown rather than MA-EPD. Christopher has a Health Care Eligibility Renewal (HC/ER) due for December 25

2012. On 12/01/12, in conjunction with his renewal, he submits a CAF requesting SNAP. 25

This means we ll need to add and/or update all of the panels necessary to add SNAP to Christopher s existing MA case including FMED. Remember that expenses used to meet an MA spenddown may be used as FMED deductions for qualifying units. Christopher provided copies of medical bills verifying that he has sufficient, recurring medical expenses to continue meeting his spenddown. 26

Let s review how to code the FMED panel for this case: Type 10 Monthly Spenddown Amount/Waiver Obligation. Verification Billing Statement (BI). Reference Number 01; Christopher incurred the expense. Begin Benefit 11/09; November 2009 is the first month we allow this expense as a deduction. Ending Benefit 04/10; budget monthly spenddown amounts as recurring expenses and six-month spenddown expenses as non-recurring. Even though this is recurring expense, code the end date with the last month of the current MA budget period. Doing so insures that spenddown expenses are not allowed longer than they should be. Remember to check and update FMED every time you redetermine health care eligibility and SNAP is open. That brings us to the Monthly Expense Amount field. Policy cautions against automatically allowing the total spenddown amount. So, what do we allow? 27

It s important to evaluate each case on an individual basis. Consider these guidelines, when determining what expenses to allow: Use a client's total medical expenses up to the amount of the spenddown. Do not assume clients will always meet their spenddown. Estimate anticipated medical bills and spenddown amounts based on previous months' bills and income. Only use the full spenddown amount, when you verified the expenses used to meet the spenddown at SNAP application or recertification and the unit has not reported further changes. Consult the Health Care Programs Manual (HCPM 24.15 Health Care Expenses) for guidance regarding Allowable Health Care expenses. Christopher provided verifications with his HC Renewal/SNAP Application establishing that he incurs enough expenses to continually meet his spenddown; therefore, we can to allow his entire spenddown amount. However, this may not happen with every case. There are tools available to help you determine what spenddown expenses to allow as FMED deductions. 28

In addition to the information we just went over, expenses must be within the SNAP time guidelines for acceptable expenses, and must be for people listed in CM 0018.12 (Medical Deductions). Some expenses used to meet a MA spenddown may be too old for SNAP purposes, and medical expenses for people other than the person eligible for the medical deduction may be used to meet a spenddown. 28

There are several tools that can be used to help determine whether expenses used to meet a client s spenddown in MAXIS can be used as FMED deductions. One tool is the STAT/BILS panel, bills coded with an Expense Type M may be too old for SNAP purposes. (This is not a copy of Christopher s BILS window and is used only for reference). In Christopher s case, we look at MMIS to see that he usually meets his spenddown so we will allow the full amount. M bills are unpaid health care expenses incurred prior to the certification period; these are old bills the client is still obligated to pay. 29

Similarly, bills coded with an Expense Type P along with a Y in the Dependent Indicator (Dpd Ind) field may be expenses for people not eligible for FMED deductions. P bills are non-reimbursable health care expenses, incurred during the current income certification period, that are not covered by MA and/or Minnesota Care. The Dependent Indicator field is used to record a household member s responsibility to pay the medical bills of a dependent living outside the household. Christopher used neither M bills nor P bills to meet his spenddown. If you encounter either of these expense types, investigate further to determine whether the expenses can be allowed as FMED deductions. 30

MMIS contains another possible tool that can assist you with determining allowable FMED deductions. Remember: Not assume clients will always meet their spenddown. AND Estimate anticipated medical bills and spenddown amounts based on previous months' bills and income. In Christopher s case, since he s currently receiving MA, we can check MMIS to see if he s been meeting his spenddown (using past circumstances as an indicator of what can reasonably be anticipated). The RSPD panel displays a record of spenddown information for recipients. A review of Christopher s RSPD panels reveals that he has met his spenddown in all but one month of the previous certification period. In one month, he used $359.16 of his $366.00 spenddown. This appears to be the exception, rather than the rule. Our research only reinforces the fact that he routinely meets his spenddown. 31

Based on the information we have, it s appropriate to code the entire spenddown amount. Let s look at eligibility results for this case. 32

MAXIS lists total medical deductions for Christopher as $331.00 ($366.00 monthly spenddown minus $35.00). 33

Christopher s monthly SNAP benefit is $141.00. Without his FMED deduction, Christopher would only be eligible for the minimum monthly allotment of $16.00. FMED deductions provide him with an additional $125.00 per month ($1500.00 per year) to put toward his food needs. 34

Remind yourself to check for possible FMED deductions anytime you have an elderly and/or disabled client who receives SNAP and has an MA spenddown. It may take some detective work to determine what expenses to allow, but your clients will appreciate the extra effort. Whether you allow the entire spenddown amount or not, remember to case note what expenses you used and why you used them. 35

The Combined Manual and the Health Care Programs Manual contain the following references: Medical Deductions CM 0018.12 Allowable SNAP Medical Expenses CM 0018.12.03 Health Care Expenses HCPM 24.15 Topics covered in this power point include, but aren t limited to: Who qualifies for FMED deductions. What expenses are allowed as FMED deductions, How expenses are budgeted, AND What expenses are allowed to meet an MA spenddown. 36